Walsh & Hoyt: Sinus Disease

In the pre-antibiotic era, spreadof infection from the paranasal sinuses to the optic nerve was not unusual. However, this is a rare occurrence now, andmost cases of sinusitis in patients with optic neuritis are fortuitous. Nevertheless, some patients with acute severe sinusitis develop a secondary optic neuritis from spreadof infection. When the infection originates from the ethmoidor maxillary sinuses, there generally are obvious signs of orbital inflammation; however, spreadof infection from the sphenoidsinus to the posterior optic nerve in the apex of the orbit or within the optic canal can be silent except for the loss of vision. Aspergillosis andother fungal infections are considerations in this clinical setting. Neuroimaging techniques, particularly CT scanning andMR imaging, generally can be usedto diagnose paranasal sinus disease.